【原】口服阿司匹林抗凝，会增加骨折不愈合风险吗？

骨折，尤其是下肢骨折，术后通常需服用阿司匹林，以有效预防深静脉血栓形成。但有基础研究表明，NASIDs药物可抑制成骨细胞活性，抑制骨愈合。

为了研究术后口服阿司匹林抗凝是否增加踝关节骨折不愈合风险，国外学者进行了研究，结果发表在2020 Injury期刊上。

Background（介绍）

由于担心骨折延迟愈合或骨不连，在骨折术后的护理期间，对使用非甾体抗炎药仍存在顾虑。然而，阿司匹林(ASA)被用于踝关节骨折治疗后的深静脉血栓形成(DVT)的化学预防越来越受欢迎。当前研究调查了接受和不接受术后ASA抗凝的患者踝关节骨折术后不愈合的发生率和深静脉血栓形成的风险。

[Background: There is hesitancy to administer nonsteroidal anti-inflammatories (NSAIDs) within the postoperative period following fracture care due to concern for delayed union or nonunion. However, aspirin (ASA) is routinely used for chemoprophylaxis of deep vein thrombosis (DVT) and is gaining popularity for use after treatment of ankle fractures. The current study examines the incidence of nonunion of operative ankle fractures and risk of DVT in patients who did and did not receive postoperative ASA.]

Methods（方法）

对2008年至2018年间因踝关节骨折需要手术固定而接受治疗的所有患者进行了回顾性研究，这些患者由三名在同一机构接受过足部和踝关节研究培训的骨科医生进行手术固定。对术后接受和未接受ASA的患者的人口统计学特征、术前合并症以及术后内科和外科并发症进行了比较。对于两组在随访6周、12周或24周后患者，通过临床检查和影像片评估愈合情况。

[Methods: A retrospective chart review was performed on all patients treated between 2008 and 2018 for ankle fractures requiring operative fixation by three Foot and Ankle fellowship trained orthopaedic surgeons at a single institution. Demographics, preoperative comorbidities, and postoperative medical and surgical complications were compared between patients who did and did not receive ASA postoperatively. For both groups, union was evaluated by clinical exam as well as by radiograph, for those with 6-week, 12-week, or 24-week follow-up.]

Results（结果）

506名患者符合纳入标准：152名接受ASA，354名未接受。6周的影像学愈合率分别为95.9% (94/98)和98.6%(207/210)(P值0.2134)。各组间影像学愈合时间无显著差异。有无ASA的患者术后深静脉血栓形成的风险无显著差异(分别为0.7% (1/137)和1.2%(4/323)；P值0.6305)。

[Results: Five-hundred and six patients met inclusion criteria: 152 who received ASA and 354 who did not. Radiographic healing at six weeks was demonstrated in 95.9% (94/98) and 98.6% (207/210) respectively (p-value .2134). There was no significant difference in time to radiographic union between groups. The risk of postoperative DVTs in those with and without ASA was not significantly different (0.7% (1/137) vs 1.2% (4/323), respectively; p-value .6305).]

表1：两组患者基线资料

表2：两组并发症、影像学愈合时间、疼痛评分等比较

Conclusion（结论）

术后使用ASA不会延迟踝关节骨折术后的影像学愈合或者影响术后深静脉血栓的发生率。这是第一项也是最大的一项研究，旨在检测阿司匹林对踝关节骨折愈合时间的影响。

[Conclusion: Postoperative use of ASA does not delay radiographic union of operative ankle fractures or affect the rate of postoperative DVT. This is the first and largest study to examine the effect of ASA on time to union of ankle fractures.]

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